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    <title>AIHRE-page4-Account resume detail</title>
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                <div class="title-body-content">ACCOUNT RESUME DETAIL</div>
                <div class="wrapper-form-account-resume clearfix">
                    <!--HTML for date-line1--> 
                    <div class="wrapper-date clearfix">
                        <span class="size-span">Date :</span>
                        <select class="sel-date">
                            <option>11/11/2000</option>


                        </select>                      
                    </div>
                    <!--HTML for reference -Line2-->
                    <div class="wrapper-reference-page4 clearfix">
                        <span class="size-span">Reference # :</span>
                        <input type="text" name="inp-reference-page4" class="inp-reference-page4 size-inp-reference" value="AIH REINSURANCE BROKER-MAHM-1074072011MO-113" />
                    </div>
                    <!--HTML for producing-broker -Line3-->
                    <div class="wrapper-producing-page4 clearfix">
                        <span class="size-span">Producing Broker:</span>
                        <select class="size-sel1-page4">
                            <option>CCA REINSURANCE BROKERS</option>
                        </select>
                        <ul class="button-form-input">
                            <li><a href="#">Add</a><div class="space3">|</div></li>
                            <li><a href="#">New</a><div class="space3">|</div></li>
                            <li><a href="#">Edit</a><div class="space3">|</div></li>
                            <li><a href="#">Delete</a></li>

                        </ul>


                    </div>
                    <!--HTML for Reinsurer -Line4-->
                    <div class="wrapper-rein-page4 clearfix">
                        <span class="size-span">Reinsurer:</span>
                        <select class="size-sel1-page4">
                            <option>PT ,Aurasi Bosowa Periskop,Jakarta</option>
                        </select>
                        <ul class="button-form-input">
                            <li><a href="#">Add</a><div class="space3">|</div></li>
                            <li><a href="#">New</a><div class="space3">|</div></li>
                            <li><a href="#">Edit</a><div class="space3">|</div></li>
                            <li><a href="#">Delete</a></li>

                        </ul>


                    </div>

                    <!--HTML for Original Insurer -Line5-->
                    <div class="wrapper-ori-insurer-page4 clearfix">
                        <span class="size-span">Original Insurer:</span>
                        <select class="size-sel1-page4">
                            <option>PT ,PlayAran Sari Ampenan</option>
                        </select>
                        <ul class="button-form-input">
                            <li><a href="#">Add</a><div class="space3">|</div></li>
                            <li><a href="#">New</a><div class="space3">|</div></li>
                            <li><a href="#">Edit</a><div class="space3">|</div></li>
                            <li><a href="#">Delete</a></li>

                        </ul>


                    </div>
                    <!--HTML for Insurance Type -Line6-->
                    <div class="wrapper-insurance-type-page4 clearfix">
                        <span class="size-span">Insurance Type :</span>
                        <select class="size-sel1-page4">
                            <option>Marine Hull & Machinery Reinsurance</option>
                        </select>



                    </div>
                    <!--HTML for Insurance Period -Line7-->
                    <div class="wrapper-insurance-period-page4 clearfix">
                        <span class="size-span">Insurance Period :</span>

                        <select class="sel-date">
                            <option>15/9/2011</option>

                        </select>
                        <span class="sp-to">To</span>
                        <select class="sel-date">
                            <option>14/9/2012</option>

                        </select>

                        <span class="sp-total-day">Total day : 365</span>
                    </div>

                    <!--HTML for Insurance Period -Line8-->
                    <div class="wrapper-sum-insured-page4 clearfix">
                        <span class="size-span">Sum Insured :</span>
                        <input type="text" name="inp-sum-insured" class="inp-sum-insured" value="IDR 7,000,000,00" />   

                    </div>

                    <!--HTML for Rate -Line9-->
                    <div class="wrapper-rate-page4 clearfix">
                        <span class="size-span">Rate :</span>
                        <input type="text" name="inp-rate" class="inp-rate" value="0.945%" />   

                    </div>

                    <!--HTML for Gross-Premium -Line10-->
                    <div class="wrapper-gross-pre-page4 clearfix">
                        <span class="size-span">Gross Premium :</span>
                        <span> IDR 66,150,000</span>  

                    </div>

                    <!--HTML for Rate -Line9-->
                    <div class="wrapper-rate-page4 clearfix">
                        <span class="size-span">Order Hereon:</span>
                        <input type="text" name="inp-rate" class="inp-rate" value="95%" />   

                    </div>
                    <!--HTML for Gross-Premium -Line10-->
                    <div class="wrapper-gross-pre-page4 clearfix">
                        <span class="size-span">Nett Premium :</span>
                        <span> IDR 62,842,000</span>  

                    </div>

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                    <div class="wrapper-placement-detail clearfix">
                        <span class="title-placement-detail">PLACEMENT DETAILTS</span>

                        <!--HTML for placement-line1-->

                        <div class="wrapper-content-placement clearfix">
                            <div class="wrapper-pt">
                                <span class="sp-pt">PT.Asurasi Bosowa Periskop : </span>
                                <input type="text" name="inp-pt" class="inp-pt size-inp1" value="95%" />   

                            </div>



                            <!--HTML for placement-line2-->

                            <div class="wrapper-brokerage">
                                <span class="sp-pt">Brokerage : </span>
                                <input type="text" name="inp-brokerage" class="inp-brokerage size-inp1" value="25%" /> 
                                <a href="#" class="link-split">Split</a>  
                                <select class="size-sel-split">
                                    <option>PT ,Aurasi Bosowa,Jakarta</option>
                                </select>
                                <input type="text" name="inp-pt" class="inp-pt size-inp1" value="12.5%" />
                            </div>

                            <!--HTML for placement-line3-->

                            <div class="wrapper-brokerage-line2">
                                <span class="sp-aih">AIH : </span>
                                <input type="text" name="inp-aih" class="inp-aih size-inp1" value="12.5%" /> 
                            </div>


                        </div>
                    </div>


                    <!-- HTML for wrapper-placement-detail-->
                    <div class="wrapper-payment-schedule clearfix">
                        <span class="title-payment-schedule">PAYMENT SCHEDULE</span>
                        <a href="#" class="button-in-form">Add</a>

                        <div class="wrapper-content-payment-schedule clearfix">

                            <table class="tbl-payment" border="0" cellpadding="0" cellspacing="0">
                                <tr class="tbl-payment-title">
                                    <td class="td-from-producing-broker">FROM PRODUCING BROKER</td>
                                    <td class="td-to-asurasi">TO ASURASI</td>
                                    <td class="td-aih-commission">AIH COMMISSION</td>


                                </tr>

                                <tr class="tbl-payment-content">
                                    <td class="td-from-producing-broker">
                                        <span class="span-tbl-payment">Due Date :</span> 
                                        <select class="sel-date">
                                            <option>1/11/2011</option>
                                        </select>

                                    </td>
                                    <td class="td-to-asurasi">
                                        <span class="span-tbl-payment">Due Date :</span> 
                                        <select class="sel-date">
                                            <option>1/11/2011</option>
                                        </select>

                                    </td>
                                    <td class="td-aih-commission">
                                        <span class="span-tbl-payment">Due Date :</span> 
                                        <select class="sel-date">
                                            <option>1/11/2011</option>
                                        </select>
                                    </td>


                                </tr>

                                <!--HTML tbl-payment-line2-->

                                <tr class="tbl-payment-content">
                                    <td class="td-from-producing-broker">
                                        <span class="span-tbl-payment">Amount :</span> 
                                        <input type="text" name="amount1" class="size-amount" value="IDR 31,421,250 " />

                                    </td>
                                    <td class="td-to-asurasi">
                                        <span class="span-tbl-payment">Amount :</span> 
                                        <span>IDR 27,493,593.75</span>

                                    </td>
                                    <td class="td-aih-commission">
                                        <span class="span-tbl-payment">Amount :</span> 
                                        <span>IDR 3,927,656.25</span>
                                    </td>


                                </tr>




                            </table>



                            <!--HTML for tbl-payment2-->

                            <table class="tbl-payment" border="0" cellpadding="0" cellspacing="0">


                                <tr class="tbl-payment-content">
                                    <td class="td-from-producing-broker">
                                        <span class="span-tbl-payment">Due Date :</span> 
                                        <select class="sel-date">
                                            <option>1/5/2012</option>
                                        </select>

                                    </td>
                                    <td class="td-to-asurasi">
                                        <span class="span-tbl-payment">Due Date :</span> 
                                        <select class="sel-date">
                                            <option>1/5/2012</option>
                                        </select>

                                    </td>
                                    <td class="td-aih-commission">
                                        <span class="span-tbl-payment">Due Date :</span> 
                                        <select class="sel-date">
                                            <option>1/5/2012</option>
                                        </select>
                                    </td>


                                </tr>

                                <!--HTML tbl-payment-line2-->

                                <tr class="tbl-payment-content">
                                    <td class="td-from-producing-broker">
                                        <span class="span-tbl-payment">Amount :</span> 
                                        <input type="text" name="amount1" class="size-amount" value="IDR 31,421,250 " />

                                    </td>
                                    <td class="td-to-asurasi">
                                        <span class="span-tbl-payment">Amount :</span> 
                                        <span>IDR 27,493,593.75</span>

                                    </td>
                                    <td class="td-aih-commission">
                                        <span class="span-tbl-payment">Amount :</span> 
                                        <span>IDR 3,927,656.25</span>
                                    </td>


                                </tr>




                            </table>




                        </div>


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                <div class="wrapper-button-form">
                    <div class="button-form">
                        <div class="button-aihre button-blue"><a href="#">SAVE</a></div>
                        <div class="button-aihre button-blue"><a href="#">CANCEL</a></div>
                        <div class="button-aihre button-blue"><a href="#">DELETE</a></div>
                        <div class="button-aihre button-blue"><a href="#">COVER NOTE</a></div>
                        <div class="button-aihre button-blue"><a href="#">DEBIT NOTE</a></div>

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                        <span class="left-foot-line1">Website Disclaimer</span><br />
                        <span class="left-foot-line2">copyright © 2011, AIH Reinsurance Brokers Limited, all
                            rights reserved</span>
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                            AIH Reinsurance Brokers Limited. Level 27 Centrepoint South, The Boulevard, Mid
                            Valley City Lingkaran Syed Putra
                            <br>
                            59200 Kuala Lumpur Tel: +6032 0969715 Fax: +6032 0969797<br>
                            &nbsp;Incorporated in Labuan, Malaysia with the Company No: LL8229<br>
                            Authorised and Regulated by The Labuan Financial Services Authority (Labuan FSA),
                            License No: BS201186<br>

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